Laparoscopy and natural orifice surgery: first entry safety surveillance step.

BACKGROUND AND OBJECTIVE: We are sharing information regarding the surveillance of the first entrance port in laparoscopic and natural orifice transvaginal endoscopy surgeries. However, we are not analyzing techniques or other surgical findings. METHOD: In this study, 160 women with previous abdominal pelvic surgeries underwent laparoscopic surgery, 145 patients underwent transvaginal Minilaparoscopy Assisted Natural Orifice Surgery (hybrid), and 3 patients underwent pure natural orifice transvaginal endoscopic surgery (pure). For those patients who had laparoscopy and hybrid procedures, the surveillance was from a laparoscope or gastroscope placed in a secondary port. Surveillance in pure cases was done using a gastroscopic retro view to see the pouch of Douglas. RESULTS: The laparoscopic procedures were gynecological procedures. The hybrid procedures included gynecological procedures as well as appendectomies and cholecystectomies; the pure procedures were cholecystectomies. There were a few minor vascular and bowel injuries in the laparoscopy group. There were no injuries in the transvaginal hybrid or pure procedures groups. CONCLUSION: The surveillance of the first entrance port can be an effective precautionary step. The cumulative experience suggests that using such surveillance in cases involving patients with prior surgery may assist in recognizing complications that might otherwise be missed.

Transvaginal single port cholecystectomy.

BACKGROUND: Transvaginal cholecystectomy encourages researchers to develop new hybrid or pure techniques for natural orifice surgery. We present an approach that combines flexible endoscopes, rigid instruments, and percutaneous needles. METHODS: A 26-year-old female patient with cholelithiasis underwent a single-port culdolaparoscopy cholecystectomy at "Hospital Regional Poza Rica" (Poza Rica, Mexico) on July 2008. The surgery was performed with only 1 transvaginal 16 mm in diameter by 32 cm in length port. The instruments included a gastroscope, laparoscopic 5 mm in diameter by 43 cm in length instruments, percutaneous reins, and hook needle. RESULTS: The patient was discharged 24 hours after surgery, which is customary for the hospital, without pain or visible scars. CONCLUSIONS: Single transvaginal port cholecystectomy using a gastroscope and laparoscopic 5 mm instruments in a parallel path is a feasible procedure in selected patients. This technique requires no abdominal ports assistance.

Transvaginal cholecystectomy without abdominal ports.

BACKGROUND: Pioneers in natural orifice transvaginal cholecystectomy are in search of an approach that uses less percutaneous assistance. The approach must be safe and affordable. The authors present a successful cholecystectomy using a technique of transvaginal operative laparoscopy with no abdominal ports. METHODS: A 24-year-old female patient with gallbladder lithiasis underwent a natural orifice cholecystectomy with only one transvaginal 12-mm port, using a laparoscope with a working channel. We used laparoscopic instruments 5 mm in diameter by 43cm in length (including a needle holder, Maryland dissector clamp, spatula, hook, suction cannula, and clip applier) and assistance with percutaneous marionette leashes. RESULTS: The patient stayed in the hospital for 24 hours and was discharged without pain and without scars. CONCLUSION: Transvaginal cholecystectomy performed using an operative laparoscope with a working channel is possible in select cases. This technique requires no abdominal ports and is an alternative to culdolaparoscopy or hybrid transvaginal procedures with flexible endoscopes.

Micropilotes

Contenido: 1.-Recopilacion historica, estructura conceptual del micropilote, proyeccion del micropilote 2.-Tipologia de pilotes especiales, caracteristicas, tipos de pilotes especiales 3.-Micropilotes, conceptos generales, consideraciones nominales, funcionabilidad constructiva, funcionabilidad operativa 4.-Proyecto y calculo del micropilote, criterios de seleccion, estrategia de calculo 5.-Ejemplo de aplicacion 6.-Conclusiones.